Postmortem blood ketamine distribution in two fatalities

Despite the reported increased use of ketamine as a recreational drug, relatively few fatalities attributed to ketamine poisoning have been documented. Two recent fatalities in which ketamine was detected are described and compared with cases previously reported in the scientific literature. Concentrations of ketamine were measured in the heart and femoral blood samples using gas chromatography with nitrogen phosphorus detection. Ketamine concentrations in a 26-year-old man whose death was attributed to ketamine intoxication were 6.9 and 1.8 mg/L in heart and femoral blood, respectively. In this case, the ketamine concentration detected in the heart blood is in agreement with the lowest concentration reported in the literature, in which ketamine intoxication was ruled as the cause of death and no other drugs were present. Ketamine concentrations in a 20-year-old man, whose death was attributed to asthma and ketamine was considered an incidental finding, were 1.6 and 0.6 mg/L in heart and femoral blood, respectively. Marked differences between heart and femoral blood ketamine concentrations were observed in both of the reported cases. This may be indicative of incomplete distribution prior to death and/or postmortem redistribution of ketamine.